Attention Deficit Hyperactivity Disorder or AD(H)D is
being diagnosed with increasing frequency in both
children and adults. Many of these individuals were
previously labeled hyperactive or minimally brain
damaged. It is estimated that 10 to 15% of school-age
children presently have this disorder.

The fourth edition of the Diagnostic and Statistical
Manual of Mental Disorders, published by the American
Psychiatric Association, classifies three types of
Attention Deficit/Hyperactivity Disorders: predominately
inattentive, predominantly hyperactive, and combined.
Six of nine symptoms of inattention, and six of nine of
hyperactivity and impulsivity are necessary.

In each case, the symptoms must be present for at least
six months to a degree that is maladaptive and
inconsistent with developmental level. In addition, some
symptoms must be present prior to age seven, and in two
or more settings (e.g. at school, work and home). There
must be clear evidence of clinically significant
impairment in social, academic, or occupational
functioning, and the impairment cannot be caused by
other disorders such as anxiety, psychosis or a
pervasive developmental disorder.

Even though it is generally assumed that people
diagnosed as having AD(H)D present a common set of
characteristics emanating from a common etiology, little
agreement is found among researchers regarding these
symptoms. Some symptoms seen in children diagnosed as
having attention deficits include:

Making careless mistakes in schoolwork

Not listening to what is being said

Difficulty organizing tasks and activities

Losing and misplacing belongings

Fidgeting and squirming in seat

Talking excessively

Interrupting or intruding on others

These symptoms are also seen in both children and adults
with learning-related visual problems, sensory
integration dysfunction as well as with undiagnosed
allergies or sensitivities to something they eat, drink
or breathe. The chart that follows illustrates this
graphically.

Symptoms

AD(H)D

(DSM-IV)

Sensory Integration Dysfunction

(Kranowitz, OEP)

Learning-related Visual Problems

(Berne, Getz)

Nutrition Allergies

(Rapp, Sahky, Zimmerman)

Normal Child Under 7

(Kranowitz)

Inattention(at least 6 necessary)

Often fails to give
close attention to details or makes careless
mistakes

Often has difficulty
sustaining attention in tasks or play activities

Often does not listen
when spoken to directly

Often does not follow
through on instructions or fails to finish work

Often has difficulty
organizing tasks and activities

Often avoids, dislikes
or is reluctant to engage in tasks requiring
sustained mental effort

Often loses things

Often distracted by
extraneous stimuli

Often forgetful in daily
activities

Hyperactivity and Impulsivity

(at least 6 necessary)

Often fidgets with hands
or feet or squirms in seat

Often has difficulty
remaining seated when required to do so

Often runs or climbs
excessively

Often has difficulty
playing quietly

Often 'on the go'

Often talks excessively

Often blurts out answers
to questions before they have been completed

Often has difficulty
awaiting turn

Often interrupts or
intrudes on others

Physicians often recommend that AD(H)D be treated
symptomatically with stimulant medication, special
education and counseling. Although these approaches
sometimes yield positive benefits, they often (may) mask
the problems rather than get to their underlying causes.

Many common drugs for AD(H)D, which have the same Class
2 classification as cocaine and morphine, can have
negative side affects that relate to appetite, sleep,
and growth. These drugs must thus be withdrawn only
under medical supervision. Placing a normal student who
has difficulty paying attention in a special class and
counseling could undermine, not boost, his self esteem.

If you have a child who enjoys being read to, who will
sit and
listen for long periods of time, but who
demonstrates attention problems when using eyes for
reading, deskwork, or homework, there is an excellent
chance that the child's attention problem is caused by
an inability to use his eyes. There is no biochemical
imbalance which allows children to attend when
information comes in through the
ears, but distracts children when
information comes in through the
eyes.

Similarly, if a child can pay attention for math, but
not pay attention for reading, there is no biochemical
imbalance which occurs when the child looks at numbers
but disappears when the child looks at words. In math,
other than story problems, there is less visual
information to cope with. The child looks at individual
numbers and, as often as not, copies them one at a time,
getting the hands into the act. In reading, the letters
are crowded together so visual problems can more easily
cause the letters to run together. Children who can
pay attention for math but lose attention for reading,
frequently have a visual problem masquerading as an
attention problem.

However, if when you read to your child, his attention
is better, but still a problem, then any number of
causes, along with vision, could be contributing to the
attention problem. For instance, your child might not
understand the words, or there could be some other
health problem making attention difficult.

Whatever the reason for your child's struggle with
attention, or behavior, untreated vision problems will
only increase frustration, trigger behavior problems,
and make things worse.

Undiagnosed vision disorders can often
be misdiagnosed as learning disabilities or even AD(H)D.
That's why we strongly recommend that before a child is
classified as learning disabled or ADD and treated
with potent prescription drugs, a full vision screening
and evaluation be performed.

Vision Therapy improves many skills that allow a person
to pay attention. Anyone diagnosed with AD(H)D should
have a complete evaluation by an optometrist trained in
Developmental Vision Therapy. Testing should be done at
distance and near point to assure that both eyes are
working together as a team. Vision is more than clarity
and is a complex combination of learned skills,
including tracking, fixation, focus change, binocular
fusion, and visualization. When all of these are well
developed, children and adults can sustain attention,
read and write without careless errors, give meaning to
what they hear and see, and rely less on movement to
stay alert.

Occupational Therapy for children with sensory
integration dysfunction enhances their ability to
process lower level senses related to alertness,
understanding movement, body position and touch. They
can then pay attention using their hearing and vision.

Biological and Nutritional Therapy for food and chemical
sensitivities and metal toxicity have also been shown to
eliminate many symptoms of AD(H)D. since biological
problems can cause secondary visual symptoms, heavy
metal detoxification is one of the most important
treatments someone with an AD(H)D diagnosis should
consider.

The public needs to understand that some optometrists,
physicians, educators, mental health professionals,
occupational therapists and allergists are all
addressing the same symptoms and behaviors. The
difference in that medication, special education and
counseling (can) mask these symptoms and behaviors,
while vision therapy, occupational therapy and treatment
of allergies can (may) alleviate the underlying causes
and thus eliminate the symptoms long-term.

When making a choice about treatment for attention
deficits consider:

Consulting a developmental optometrist for a vision
evaluation

Having a child evaluated by an occupational
therapist with expertise in sensory processing
problems